CARE HOMES FOR OLDER PEOPLE
Alicia Nursing Home 109-115 Marsh Road Luton Bedfordshire LU3 2QG Lead Inspector
Katrina Derbyshire Unannounced Inspection 18th May 2006 10:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alicia Nursing Home Address 109-115 Marsh Road Luton Bedfordshire LU3 2QG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 560500 01582 561574 Apex Care Homes Limited Mary Mukangwa Tengenesha Care Home 61 Category(ies) of Dementia (16), Dementia - over 65 years of age registration, with number (16), Mental disorder, excluding learning of places disability or dementia (24), Mental Disorder, excluding learning disability or dementia - over 65 years of age (24), Physical disability (21), Physical disability over 65 years of age (21) Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. No service user under the age of 50 may be accommodated at the home unless an additional condition has been made. Service users admitted from 25.02.06 in the category of MD or MD(E) will be accommodated in the Wingfield Unit. Service users admitted from 25.02.06 in the category of DE or DE(E) will be accommodated in Alicia on the Yellow floor (Middle Floor). Service users admitted from 25.02.06 in the category of PD or PD(E) will be accommodated in Alicia on the Red and Green floors (Ground and top floor). The three service users identified in the application letter dated 21.02.06 in the category of LD may be accommodated at the home until such time as a change of placement is required. The one service user identified in the application letter dated 21.02.06 in the category of LD(E) may be accommodated at the home until such time as a change of placement is required. The one service user under the age of 50 years identified in the application letter dated 21.02.06 in the category of PD may be accommodated at the home. The one service under the age of 50years identified in the application letter dated 21.02.06 in the category of DE may be accommodated at the home. 7th October 2005 6. 7. 8. Date of last inspection Brief Description of the Service: Alicia Nursing home is situated on the Marsh Road in Luton close to a variety of local amenities such as shops, places of worship and public houses. The home provides accommodation over three floors within one building and over two floors in another building known as Wingfield unit. For operational purposes each floor provides its own style of care for a particular group of service users. Attached to the home is a day centre that is staffed to provide activities for any of the residents who wish to attend Monday to Friday. The care staff can open this centre at weekends or in the evenings. The home has a small-enclosed garden with parking space for staff and visitors. The home is close to the M1
Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 5 and the A6 and is on a bus route. Leagrave railway station is easily accessible. The fees for this home vary from £440.04 per week, to £750.00 per week, depending on the funding source. If a higher staff ratio is required due to the assessed needs of the resident, fee levels will be above this figure based on the additional staffing costs. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit was carried out on 18th May 2006. The manager Mary Tengenesha was present throughout the inspection alongside the Operational Manager from the company. During the inspection all areas of the home were visited and the inspector spent time with many of the residents in the sitting areas of the home. The care of four residents was examined by looking at their records and interviewing the residents and staff who look after them. The views of residents, relatives and visiting professionals were also received and their feedback has been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit, reporting and strategy meetings. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: What has improved since the last inspection?
Many things have improved since the last inspection. The home are now clear on the residents that are allowed to move into the home so they stay within their registration and are focused on making sure the staff that look after them are trained to do so. They have also looked at the way staffing work at the
Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 7 home there are two Deputy Managers in the home now and Registered Nurses have responsibilities in the areas that they work. This means the overall standards of care has improved and staff are able to specialise in certain areas for example caring for people with dementia. The home has also made changes to the way that they manage the medication of residents, and the Manager makes checks to verify that the homes procedures are being followed. The way the home orders, stores and administers medicines is good and staff receive training to update their knowledge in this area. Residents now receive their medication when they should and records of this are kept at the home. The way that staff talk with residents has also changed and improved. Staff when speaking to residents do so in a supportive and courteous way, when they address a resident it is how the resident has chosen to. Residents are treated in a dignified manner. Also when the home makes a referral of a possible concern under a local scheme that is in place to protect vulnerable people, they now do this well and make sure all the people that need to be informed have been. They complete a report that has all the information needed and act in the best interests of the residents’, this means that the residents are protected in this area. What they could do better:
Although the home has been working to improve the way they write about the care that is needed by the residents, there are still improvements to be made. The documents known as care plans sometimes are very good but this is not the case in all parts of the home. One resident with a catheter did not have sufficient guidance to staff in the care of this. Another resident receiving dressings by the nurses in the home also did not have information that was clear enough to show how often it should be changed or the dressing type to be used. It is very important that all information is included in these documents, to make sure all residents receive the treatment and support needed to meet their assessed needs. The home is good at arranging access to healthcare for the residents at the home and information from these specialists are kept within the care records. However they need to make sure that guidance in these areas are recorded for all residents. One resident receiving insulin injections by the nursing staff did not have the information of how much and what action should be taken by staff if their blood sugar was to high or low. Another resident had been assessed as displaying on occasions inappropriate behaviour in pubic, it was not clear what staff should do to protect the resident, other residents and themselves. There must be systems in place to ensure the healthcare needs of all residents are met at all times.
Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The information available to potential residents is sufficient for them to be able to make an informed decision about moving into the home. EVIDENCE: The statement of purpose and service user guide is a well set out document and describes the range of needs that the home can meet, the complaints procedure, the qualifications and experience of the Registered Provider and staff alongside all other information as detailed within schedule 1.Discussions with staff confirmed that the homes statement of purpose was both accessible and that the home had ensured that its content had been shared in the home. The residents care records examined included comprehensive assessment documentation. The assessment process covered all of the areas identified in the standard, and set out the needs of each resident. Other relevant assessment information from other professionals was present where appropriate.
Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 11 A previous requirement relating to the homes registration categories was noted to have now been met. The homes revised certificate of registration was displayed in the home, residents living at the home had assessed needs that were now within the categories of registration. The home does not provide intermediate care. . Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The standard of care planning at this home remains insufficient to ensure that all information required by staff is in place, to ensure all assessed needs of residents are met. EVIDENCE: Care plans examined were of a mixed standard. One plan seen was very clear in its guidance and instructions to staff and was of a very high standard. However one residents’ plan did not make clear how staff should care for a resident with a catheter in place or the support that they would need to provide. Other examples were discussed with the management on the day of the visit to the home including insufficient information relating to dressings of a pressure wound. Within the care records risk assessments were in place in relation to pressure area care, moving and handling, falls, nutrition and dependency. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 13 It was observed sufficient equipment was present in the home to maintain pressure area care for the residents. Care records contained documentary evidence to support that access to external healthcare professionals, for example chiropody, dentist, General Practitioner and optician took place. However actions to be taken and the support required to maintain health needs to improve. One example is one resident receiving insulin did not have appropriate guidance on action to be taken if their blood sugar was to low or high or the amount that was to be administered was not within their care plan. Resident care records contained medication profile sheets; these listed all medications past and present that the resident had been prescribed. Entries on these documents matched the homes medication administration records and the medication stocks for the residents. Residents through discussion confirmed that they felt that staff treated them in a dignified manner and many commented on ‘how kind’ the staff were. Staff were also seen to knock on doors and wait for consent to be given prior to entering. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems and support to residents in maintaining personal relationships is good, and enhances the resident’s standard of life. EVIDENCE: The day centre in the home is run between Monday and Friday by dedicated staff specifically employed to focus on meeting the social needs of the residents. Alongside in house provision outside entertainment is also arranged and trips out. A revised activities programme has recently been implemented in which specific events and programmes are held for the varying residents living at the home relating to their assessed diagnosis. Residents confirmed they are able to bring personal possessions into the home and evidence of this was seen in residents’ rooms. Residents said that they are consulted and are given choices as to how they conduct their lives within the home; choices offered included meals, activities and relationships. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 15 Nutritional risk assessments were seen on the care records of residents. A choice of meals was available, a brief observation of the lunchtime meal was made, and it was noted to be unrushed and enjoyed by the residents. Feedback from residents and relatives through comment cards showed that the home provided sufficient support to residents, in supporting them to maintain close relationships with family and friends. One relative said “ everyone is very friendly every time l visit and I am able to see mum in private, that’s important to both of us”. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The training and staff’s knowledge on the protection of vulnerable adults sufficient to ensure all residents are protected in accordance with local policy. EVIDENCE: The homes complaints procedure is clearly displayed and detailed within the homes statement of purpose. All residents spoken with knew of their right to complain and to whom they could speak to if they ever had any concerns. Records of any complaints received are kept within the home and the action taken by the home in response. However the home is advised that when responding to complainants that they are careful not to respond in a defensive manner. One complaint received from Luton Primary Care Trust earlier in the year had been responded to, however the home should have been more effective in its management of this and was discussed with the management of the home at this visit. Since the previous inspection staff have continued to be been trained in the protection of vulnerable adults and be given further guidance in reporting referrals under the local scheme, this had occurred in response to a requirement made at that time. A referral made by the home in May 2006 was seen to have been carried out to a good standard, the home had been prompt in making residents safe, contacting the Police and referring it to the leading authority.
Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 17 Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is clean and free of odours making it a pleasant environment for the residents to live in. EVIDENCE: The location and layout of the home was noted to be suitable for its purpose. Furnishings and fittings were domestic and of a good standard. The communal areas in the home are clean and tidy and residents rooms contain personal items, which reflected their individual personalities. The communal areas of the home are clean and free from offensive odours at as were the individual rooms of residents seen. Policies are in place regarding infection control and staff were seen to be using protective clothing. Hand washing facilities are sited in the areas where infected material/clinical waste is handled.
Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 19 Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The training of staff in the care of residents is sufficient to ensure they have a satisfactory level of knowledge to provide care in accordance with current best practice guidance. EVIDENCE: Comments from residents on this inspection included that the staff were kind, competent and caring and that they felt there were sufficient numbers on duty to meet their needs. Relatives comments received in the main also reported that they felt there to be enough staff to provide care to the residents. Sample checks of staff files were undertaken to look at recruitment practices it was noted all files contained application forms, references and photographic evidence of identity. In addition evidence was seen that a criminal records bureau check had also been undertaken on all staff. Staff had undertaken a variety of training and through discussion they confirmed that the home had supported them in doing so. Training records were noted to be clear and information relating to this is within the homes statement of purpose. Comments from Hertfordshire Social services were also received in May 2006 to report that when they had undertaken resident reviews they had found improvements in the care at the home.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems at this home for managing health and safety are good protecting the residents through reducing risks in this area. EVIDENCE: Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 22 The Home Manager has many years experience, which is directly relevant to the role of manager in the home and in addition is a Registered General Nurse, Registered Mental Health Nurse and holds the Registered Managers award. Interaction observed between her and the residents and staff was supportive and caring. Staff informed the inspector that the Home Manager was very supportive to them and provided sufficient and effective management and leadership. The home has a system for gaining the views of residents and relatives and in addition undertake a quality review in areas such as medication, maintenance and staff training. They are in the process of using these views to influence the running of the home an example of this is the changes that have been made to the activities available in the home. The homes Health and Safety policy was noted to contain all required information. Staff confirmed that they had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen on the service users care files that were tracked on this inspection. All major equipment is serviced regularly and the home maintains documentation to support this and when safety checks such as recording water temperatures have been undertaken. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1a)& 15 Requirement Care plans must contain sufficient detail for the needs of residents to be met and carried out. (Previous requirement timescale of 01/01/05 and 30/06/05 30/11/05 not met in full) Systems must be in place to identify possible risks directly associated with service users diagnosis in consultation with health care professionals. (Previous requirement timescale of 15/11/05 not met in full) Timescale for action 15/07/06 2. OP8 12 & 13. 15/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP16 Good Practice Recommendations The home should be cautious in its response to
DS0000017661.V295877.R01.S.doc Version 5.2 Page 25 Alicia Nursing Home complainants so that a defensive stance is not taken. Alicia Nursing Home DS0000017661.V295877.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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